Koch Says He Saw Hospital Plan For Homeless as Spur for the State

By BRUCE LAMBERT

Published: September 4, 1987

Mayor Koch said yesterday that his plan to hospitalize more mentally ill homeless people in the face of warnings from a key aide that services were already overloaded was calculated to spur New York State to provide more facilities.

Asked if he had intended to put pressure on the state, Mr. Koch said in an interview: ''Yes, of course, that was part of my purpose, to energize the state. We can't do it by ourselves, but we're not going to wait till everybody else is ready to move forward.''

State officials, however, said they had already been expanding their programs for the homeless mentally ill before the Mayor announced his plans.

The debate began last week when the Mayor said the city would begin next month to hospitalize, against their will, homeless people who cannot care for themselves. He estimated that 500 people would be taken to hospitals annually.

The homeless people would be picked up by city teams, treated initially in a new 28-bed unit in Bellevue Hospital Center and then transferred to state hospitals or other facilities.

Peter P. Smith, president of the Partnership for the Homeless, which coordinates 372 churches and synagogues that shelter up to 1,500 people a night, endorsed the Koch plan, saying: ''This is the classic way in which pressure is put back onto the system to produce what is needed. The lack of facilities should not be used as an excuse for not taking the first step.'' An Aide's Warning

Mr. Koch's decision came despite a memorandum from the president of the New York City Health and Hospitals Corporation, Dr. Jo Ivey Boufford, warning that without additional facilities, the new patients would face ''inappropriate discharge'' or retention in overcrowded psychiatric wards.

''Without the assured access to the critically needed after-care services and state-sponsored supportive housing, the improvement in patient care anticipated with this initiative will not be realized,'' she wrote.

The hospitals agency said this week that it had 1,126 adult acute psychiatric-care beds in the municipal hospitals and that they were frequently filled. City officials said that since January, they had referred 835 cases to the state but only 333 were accepted.

The Mayor's decision to proceed did not conflict with Dr. Boufford's warning, he said, because ''it points out failures of the state, and that shouldn't stop us from what we should do.''

''What are we supposed to say? Until the state does its job, we're not supposed to do ours?''

Later in the day, Mr. Koch elaborated, saying the strategy of prodding the state was ''a side issue'' to his main purpose of ''helping hapless people.''

But the Mayor did not take back his original comments, in which he criticized the state for past inaction and praised it for what he called a new receptiveness. Getting People 'Energized'

''Of course, the state has to do a lot of things, and they're not doing them, and they have been resistant in the past,'' he said. ''But the statements we're getting now from the state people to our people are very cooperative, so I think we have energized them. Our initiative is causing others to be energized, and I'm happy about that.''

State officials, however, said they have been constantly expanding their programs and will continue to do so. They also said they had been working with the city before Mr. Koch announced his proposal.

''We are always examining the entire scope of services available in New York City and have indicated to the Mayor our willingness to cooperate,'' said Robert M. Spoor, spokesman for the state's Office of Mental Health.

State psychiatric hospitals have 17,000 beds for long-term care and 2,000 for short-term care, Mr. Spoor said. Mayor Koch has not said how many more might be needed.

Further expansion of mental-health facilities, Mr. Spoor said, will depend on how many additional patients Mr. Koch's action will add to the system: ''We don't know what the additional burden will be as a result of the Mayor's initiative. We have to wait to see what it produces.'' More Community Residences

Meanwhile, Mr. Spoor said, the state is increasing community residences for mental patients under the principle of providing ''the least restrictive environment'' needed for each patient, instead of relying on old-fashioned mass mental institutions.

The community residences range from closely supervised group homes to scattered apartments with support services, including clinics, visits by social workers, transportation, counseling and vocational training.

There are now such residences for 2,170 patients in the city, a total that has doubled in the past three years, with places for 1,000 more patients planned in the next two years, Mr. Spoor said. Rise in Spending

In the past decade, he said, the state budget for community residences has risen from $1.5 million to $70 million, with $40 million going to facilities in the city. The budget for support services has risen from $21.3 million to $65 million statewide, of which $28 million goes for patients in the city.

Further, several charitable groups have expressed interest in developing residential care centers for adults, similar to single-room-occupancy hotels, and that program is to provide 300 more beds during the next two years, Mr. Spoor said.

Commenting on the Mayor's statement, Robert M. Hayes of the Coalition for the Homeless questioned why the city, if it is sincere, has not responded to invitations to join his group's lawsuit trying to force the state to act.

The Mayor also lashed out at criticism from Senator Nicholas A. Spano, chairman of the State Senate's Mental Hygiene Committee, who expressed fear of returning to the ''dark ages'' of large institutions.

''He's saying that if you give patients to the state, you're turning them over to a snake pit,'' Mr. Koch said. ''He's in charge of the snake pit - why doesn't he stop it from being a snake pit?''

Senator Spano, a Republican from Yonkers, said he is not in charge of the system. He conceded that the state should do more, but he also accused the city of ''dragging its heels'' in helping provide sites for state facilities.